Provider Demographics
NPI:1114230869
Name:ZOLLOS, BONNIE ELLEN (MA)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:ELLEN
Last Name:ZOLLOS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:BONNIE
Other - Middle Name:ELLEN
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:255 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-1943
Mailing Address - Country:US
Mailing Address - Phone:440-243-4000
Mailing Address - Fax:
Practice Address - Street 1:255 FRONT ST
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1943
Practice Address - Country:US
Practice Address - Phone:440-243-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP437405235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist